REMOTE  STORAGE 


THE  ABUSE  OF  BROMIDES 
IN  EPILEPSY. 

BY 

WM.  P.  SPRATLING,  M.D., 

SONYEA,  N.  Y. 

Reprint  from  the  Medical  Record 

September  2,  iqos 

WILLIAM  WOOD  AND  COMPANY 

NEW  YORK 


THE  ABUSE  OF  BROMIDES  IN  EPILEPSY. 

By  WM.  P.  SPRATLING,  M.D., 

SONYEA,  N.  Y. 

MEDICAL  SUPERINTENDENT  OP  THE  CRAIG  COLONY  FOR  EPILEPTICS; 

PRESIDENT  OF  THE  NATIONAL  ASSOCIATION  FOR  THE  STUDY  OF 
EPILEPSY:  MEMBER  OF  THE  AMERICAN  NEUROLOGICAL 
ASSOCIATION,  &C. 

Years  ago  I became  convinced  that  the  bromides  as 
generally  administered  did  vastly  more  harm  in  the 
treatment  of  epilepsy  than  they  did  good,  and  the  ten 
years’  experience  I have  had  at  Sonyea  in  the  treat- 
ment of  nearly  two  thousand  cases  has  strengthened 
that  conviction.  I do  not  hold  that  the  bromides  al- 
ways do  harm,  or  that  they  fail  sometimes  to  do  good 
in  the  treatment  of  epilepsy.  I think  they  have  a 
limited  range  of  usefulness  in  the  power  they  possess 
of  suppressing  epileptic  convulsions. 

Biiticansay  this  without  reservation : I have  yet 
to  see  the  first  case  of  epilepsy  cured  by  the  bromides 
atone.  Personally  I have  never  given  the  bromide  of 
potassium  to  an  epileptic.  In  certain  of  the  epilepsies 
in  women  in  which  the  attacks  group  themselves 
about  the  menstrual  epoch,  I have  used  some  of  the 
other  salts  with  good  results,  but  even  then  the  case 
must  be  carefully  selected. 

When  visiting  the  Bielefeld  Colony  in  Germany 
years  ago,  I learned  that  the  bromides  were  con- 
stantly being  less  employed.  At  the  Craig  Colony 
the  average  dose  of  the  drug  now  is  fifteen  grains  a 
day,  five  grains  to  a dose.  Some  patients  get  more 
than  this,  while  many  get  none. 


Copyright  , William  Wood  and  Company. 


A short  time  ago  the  amount  of  the  drug  that  was 
being  used  was  reduced  nearly  one-half.  The  result 
was  a considerable  temporary  increase  in  the  number 
of  attacks,  but  in  a little  while  the  attacks  fell  to  their 
former  number,  most  of  the  patients  showing  mental 
and  physical  improvement  while  free  from  bromism. 
To  stop  the  bromides  in  a chronic  epileptic — if  it  be 
cautiously  done — is  sometimes  more  valuable  than  to 
keep  him  saturated  with  them  to  the  point  of  tolera- 
tion. There  is  no  better  proof  of  the  failure  of  the 
bromides  to  cure  epilepsy  than  to  stop  them  after 
years  of  use  and  watch  the  attacks  double  or  treble  in 
number. 

Sudden  withdrawal  of  the  bromides  without  an 
effective  substitute  is  never  advisable.  Some  epilep- 
tics will  stand  it,  but  others  will  be  sure  to  succumb 
to  serial  attacks,  or  to  the  graver  condition  of  “status 
epilepticus”  which  so  frequently  terminates  in  death. 
Most,  probably  all,  patent  nostrums  recognize  the 
power  the  bromides  have  of  effecting  false  and  su- 
perficial “cures”  in  epilepsy — cures  that  terminate 
with  the  withdrawal  of  the  nostrum.  During  the 
past  nine  years  I have  personally  analyzed  twenty- 
seven  inch  nostrums  and  I found  the  basis  of  them 
all,  without  exception,  was  the  bromide  of  potassium. 

In  the  hands  of  laymen  these  nostrums  do  infinite 
harm.  In  contradistinction  to  the  one  point  of  value 
bromide  possesses  in  the  treatment  of  epilepsy — that 
of  lessening  cortical  irritability — there  are  numerous 
results  from  its  unscientific  use  that  sometimes  make 
it  a positive  menace  to  the  recovery  of  the  patient.  I 
' am  convinced  that  recoveries  occasionally  occur  in 
\ epilepsy,  not  because  of  the  use  of  the  drug,  but  in 
Wpite  of  it. 

The  most  remarkable  recovery  from  epilepsy  I 
have  known  was  in  a man  who  had  suffered  from  the 
disease  eighteen  years,  who  had  in  all  50,000  to 


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REMOTE  STORAGE 


60,000  seizures,  who  was  given  for  years  120  to  140 
grains  of  bromide  with  no  effect  but  a steady  depre- 
ciation in  his  physical  condition,  and  who  began  to 
make  a complete  recovery  after  entering  the  Colony 
where  the  amount  of  the  drug  was  reduced  month  by 
month  until  at  the  end  of  the  eighth  month  he  was 
getting  fifteen  grains  a day  only.  In  this  case  an 
effort  was  made  to  correct  deep  seated  errors  in 
metabolism  by  giving  a drug  that  only  aug- 
mented the  primary  fault.  This  single  instance  is 
worth  little  more  than  to  show  that  epilepsy  is  not 
always  relieved  by  bromide  alone.  But  the  point  is : 
there  are  thousands  of  other  cases  like  it. 


The  chief  difficulty  in  giving  the  bromides  lies  in 


our  inability  to  prescribe  the  precise  individual  dose 
the  patient’s  condition  demands.  We  have  paid  too 
much  attention  in  the  past  to  the  number  of  grains 
administered,  and  too  little  to  fesuHs^atfamed.  Not- 
withstanding  its  comparative  harmlessnes'sTfhe  drug 
should  be  used  in  epilepsy  with  the  same  scrupulous 
care  that  we  use  aconite  in  fever  or  digitalis  in  heart 
disease  if  we  expect  to  make  our  patients  feel  its 
value,  and  miss  its  faults. 

In  no  case  let  us  forget  there  is  a point  of  physio- 
logical toleration — of  therapeutic  usefulness,  beyond 
\j*  which  we  should  not  go.  Barring  exceptional  cases, 
it  is  never  necessary  to  push  it  to  the  point  of  induc- 
ing bromic  acne,  while  to  cause  bromic  dementia  with 
it,  is  a blunder  inexcusable.  For  some  years  after  its 
opening  the  number  of  patients  admitted  to  the  Craig 
with  bromic  dementia  was  greater  than  now. 


Blunting  of  the  intellectual  faculties  is  a notable 
result  of  the  bromides,  and  is  first  shown  in  loss  of 
memory.  I formerly  thought  this  condition  was  du£ 
to  the  seizures,  but  witnessing  the  complete  restora- 
tion of  memory  in  so  many  cases  after  the  bromides 


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had  for  some  time  been  withdrawn,  there  was  no 
alternative  but  to  ascribe  it  to  the  use  of  the  drug. 

Since  the  origin  of  the  Colony  treatment  of  epi- 
lepsy the  bromides  have,  to  a certain  extent,  declined 
in  favor.  This  decline  was  a logical  result  of  the 
rHrecognition  of  the  necessity  for  the  treatment  of  the 
individual  in  toto,  instead  of  aiming  at  the  suppres- 
sion of  a symptom  only. 

We  have  only  to  consider  the  physiological  effects 
of  the  bromides  to  understand  why  they  are  of  so 
little  use  in  epilepsy.  On  the  respiration  ordinary 
doses  produce  but  little  effect;  in  larger  doses  they 
act  as  depressants.  On  the  alimentary  canal  they 
often  act  disastrously — irritating  the  mucous  mem- 
brane and  interferring  with  the  reflex  activity  of  the 
stomach  in  a way  to  check  the  normal  secretion  of 
gastric  juice,  which  impairs  digestion.  They  cause 
constipation,  heavy  coating  of  the  tongue,  and  foul 
breath,  a bad  taste  and  a pasty  feeling  in  the  mouth, 
loss  of  appetite  and  not  infrequently  nausea  and 
diarrhea. 

On  nutrition  they  act  unfavorably  in  some  cases 
by  lessening  metabolic  changes  through  depressing 
the  nervous  system.  They  produce  unsteady  gait ; 
myasthenia,  particularly  noticeable  in  the  legs ; de- 
pression and  often  loss  of  sexual  vigor  ; forgetfulness 
and  slight  degrees  of  aphasia,  usually  shown  in  the 
misuse  of  words  and  the  wrong  formation  of  sen- 
tences. 

On  the  temperature  ordinary  doses  have  no  effect ; 
in  larger  doses  they  lower  the  heat  of  the  body  by  de- 
pressing the  heart’s  action  and  possibly  by  contract- 
ing the  arteries,  a fact  apparently  established  through 
the  experiments  of  Brown-Sequard,  Mairet,  and 
Amory.* 

Some  therapeutists  assert  that  the  bromides  de- 
crease tissue  waste.  I do  not  share  this  belief,  but  I 


4 


am  convinced  that  the  opposite  is  oftener  the  case. 
Epileptics  are  notoriously  great  eaters,  and  any  sim- 
ple increase  in  weight  in  them  is  not  to  be  ascribed  to 
the  bromides,  but  to  their  food  habits. 

Anemic,  emaciated,  and  feeble  epileptics  who  have 
been  taking  large  routine  doses  of  bromides  for  years 
before  entering  the  Colony  and  who  suffer  its  partial 
or  complete  withdrawal  after  they  begin  Colony  life, 
show  an  increase  in  weight  and  a gratifying  general 
improvement  difficult  to  believe. 

It  is  an  extraordinary  fact  that  since  the  introduc- 
tion of  the  bromides  in  the  treatment  of  epilepsy  by 
Laycock,  fifty-seven  years  ago,  the  prognosis  of  the 
disease  (barring  certain  well  regulated  forms  of 
treatment)  is  no  better  now  than  it  was  then. 

After  a few  years  of  abandonment  of  the  bromides 
with  the  employment  of  other  harmless  depressants 
in  their  stead,  and  a general  recognition  of  the  prin- 
ciple of  first  treating  the  individual  instead  of  a 
symptom  of  his  disease,  we  should  soon  attain  a 
truer  estimate  of  the  very  limited  value  of  the  bro- 
mides in  epilepsy  than  we  have  to-day. 


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